External Review of Health Plan Denials of Mental Health Services: Lessons from Minnesota
Authors: Foote, Susan; Virnig, Beth; Bockstedt, Lindsay; Lomax, Zeia
Source: Administration and Policy in Mental Health, Volume 34, Number 1, January 2007 , pp. 38-44(7)
Abstract:There has been concern that health plans unfairly deny claims for mental health services. This study examines a unique Minnesota program that resulted from a legal settlement. An independent panel reviews all mental health service denials in the state’s three largest health plans. Our study analyzed every case file (N = 4717) the panel reviewed from January 2002 to August 2005. This unique dataset provides insight into health plan behavior. The findings show that the panel reversed only 2.9% of denied claims, suggesting inappropriate denials were rare. However, the panel decisions have made important improvements in contract language and patient communications.
Document Type: Research Article
Affiliations: Email: firstname.lastname@example.org
Publication date: January 1, 2007